Future Benefits of Intensive Diabetes Control
By Stacie Overton, Ivanhoe Health Correspondent
NEW ORLEANS (Ivanhoe Newswire) -- New research presented at this year's Annual Meeting of the American Diabetes Association shows tight control of type 1 diabetes has more impact than was once thought.
Even if blood sugar control decreases over time, researchers now know patients who have tight control early on in their disease have reduced atherosclerosis and other complications years later. David Nathan, M.D., from Harvard, and John Lachin, ScD, from George Washington University, presented the new information. The Diabetes Control and Complications Trial began 20 years ago with 1,441 people with type 1 diabetes. Patients either had intensive control, consisting of several insulin injections and blood sugar checks throughout the day, or conventional control, which consisted of only one or two injections and blood checks daily. Results of that study show the intensive therapy group had fewer complications and significantly better blood sugar control.
In a study following up on the DCCT, researchers found the blood sugar levels of patients from the intensive control group raised slightly over the subsequent eight years, while in the conventional group, average blood sugar levels lowered slightly. Thus, the two groups had similar blood sugar levels and control eight years later.
Now, new information shows even though their current disease control was similar, those who were previously maintaining intensive control have significantly less calcification in their coronary arteries than those who were on conventional control. Lachin explained, "Intensive control, bringing blood glucose levels as close to normal as possible for an average of six and a half years, yielded reduced atherosclerosis even followed by eight years of less effective control, compared to those who never achieved tight control."
Dr. Nathan says those formerly on intensive therapy have also continued to display a significantly reduced progression of microvascular disease (vision damage, nerve damage and kidney damage). He says this persistent effect of former blood sugar control cannot be easily explained by any acute effect of blood sugar levels. He says, "Metabolic memory may be the best model for understanding the results."
Lachin concurred, saying, "What we're seeing is this profound effect of glycemia on the long-term risk of complications." He continued, "The critical message of this research is that good glucose control should be implemented as early as possible. A high A1C level (average blood sugar over three months) causes the greatest damage in the first few years of diabetes."
This article was reported by Ivanhoe.com, who offers Medical Alerts by e-mail every day of the week. To subscribe, go to: http://www.ivanhoe.com/newsalert/.
SOURCE: Reported at the 63rd Annual Meeting of the American Diabetes Association, New Orleans, June 13-17, 2003
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